TIPS术对肝门脉血流动力学及肝储备功能的影响
发布时间：2018-10-17 14:26
【摘要】：背景:经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)历经20余年的发展,已经成为控制门脉高压出血、难治性腹水的一种治疗选择。但术后仍存在一些并发症的风险,如肝性脑病,分流道失效等。肝门脉血流指数能够反映门脉血流的相对多少,其在TIPS术后的变化尚未有文献报道。ICG(吲哚菁绿)试验目前是国际上公认的评价肝脏储备功能的一项可靠的方法,其在TIPS术中的应用尚未有文献报道。因此,TIPS术后肝门脉血流指数和ICG的变化及与TIPS术后并发症的关系值得研究和探讨。目的:观察TIPS术治疗食道胃底静脉曲张破裂出血和难治性腹水的临床疗效以及术后肝性脑病,分流道失效等并发症的发生,分析比较各项临床指标(肝功能,血氨,门脉血流指数,ICGR15)在TIPS术后的变化。方法:前瞻性研究2015年11月-2016年12月于浙江大学附属第一医院行TIPS术治疗的肝硬化门脉高压患者14例,术前完善血常规,肝功能,血氨,肝门脉ECT,ICG试验,TIPS术中及支架置入成功后分别测门静脉压力,术后第二天复查血常规,肝功能,血氨,3天内复查肝门脉ECT,ICG试验,分析比较各项临床指标的变化。同时术后随访2周-12月,观察术后并发症的发生。采用SPSS18.0进行统计分析,P0.05视为有显著性差异。结果:14例行TIPS术的患者均手术成功,其中13例胃底食道静脉曲张破裂出血患者住院期间未再出血,另1例难治性腹水患者术后腹水显著减少。门脉压力由TIPS术前的31.36±3.20mmHg下降至术后的22.79±4.21mmHg(P0.01),门脉血流指数由 42.69±11.84%下降至 18.69±9.24%(P0.01)。ALT 由 18.67±10.42U/L 上升至86.17±80.46U/L(P0.05),AST 由 24.08±9.27U/L 上升至 86.67±71.43U/L(P0.05),TBIL 由 19.50±10.28umol/L 上升至 41.93±34.23umol/L(P0.05),血氨由36.93±14.81umol/L 上升至 84.36±56.35umol/L(P0.05),ICGR15 由 17.5±8.7%上升至27.2±7.6%(P0.05),而胆碱酯酶,白蛋白,白细胞,血红蛋白,血小板在TIPS术后无显著变化(P0.05)。一名患者于术后2周发生肝性脑病,另一名患者术后半年因分流道失效再次出现胃底食道静脉曲张破裂出血。结论:TIPS术后患者门脉压力较术前显著下降,对防治胃底食道静脉曲张破裂出血和顽固性腹水近期临床疗效较明显,但术后患者肝功能受到一定程度损害,肝脏储备功能及门脉血流指数较术前下降,远期可以出现肝性脑病,分流道失效等并发症。
[Abstract]:Background: Transjugular intrahepatic portosystemic shunt (transjugular intrahepatic portosystemic shunt,TIPS) has been developed for more than 20 years and has become a therapeutic option for controlling portal hypertension hemorrhage and refractory ascites. However, there are still some risks of complications, such as hepatic encephalopathy, shunt failure and so on. The hepatic portal blood flow index can reflect the relative amount of portal blood flow. The changes of portal blood flow after TIPS have not been reported in the literature. The. ICG (indocyanine green (. ICG () test is an internationally accepted and reliable method for evaluating liver reserve function. Its application in TIPS surgery has not been reported. Therefore, the changes of hepatic portal blood flow index and ICG after TIPS and their relationship with postoperative complications of TIPS are worth studying and discussing. Objective: to observe the clinical efficacy of TIPS in the treatment of esophageal variceal bleeding and refractory ascites, and to analyze and compare the clinical parameters (liver function, blood ammonia), and the occurrence of postoperative complications such as hepatic encephalopathy and shunt failure. Changes of portal blood flow index (ICGR15) after TIPS. Methods: from November 2015 to December 2016, 14 patients with hepatic cirrhosis and portal hypertension underwent TIPS from November 2015 to December 2016. Portal vein ECT,ICG test, portal vein pressure were measured during TIPS operation and stent implantation, blood routine examination, liver function, blood ammonia and hepatic portal ECT,ICG test were performed on the second day after operation, and the changes of clinical indexes were analyzed and compared. At the same time, follow up 2 weeks to 12 months, observe the occurrence of postoperative complications. Using SPSS18.0 statistical analysis, P0.05 as a significant difference. Results: all the 14 patients who underwent TIPS were successfully operated. 13 patients with esophageal variceal bleeding did not rebleed during hospitalization, and 1 patient with refractory ascites decreased ascites significantly after operation. 闂ㄨ剦鍘嬪姏鐢盩IPS鏈墠鐨，
本文编号：2276975
[Abstract]:Background: Transjugular intrahepatic portosystemic shunt (transjugular intrahepatic portosystemic shunt,TIPS) has been developed for more than 20 years and has become a therapeutic option for controlling portal hypertension hemorrhage and refractory ascites. However, there are still some risks of complications, such as hepatic encephalopathy, shunt failure and so on. The hepatic portal blood flow index can reflect the relative amount of portal blood flow. The changes of portal blood flow after TIPS have not been reported in the literature. The. ICG (indocyanine green (. ICG () test is an internationally accepted and reliable method for evaluating liver reserve function. Its application in TIPS surgery has not been reported. Therefore, the changes of hepatic portal blood flow index and ICG after TIPS and their relationship with postoperative complications of TIPS are worth studying and discussing. Objective: to observe the clinical efficacy of TIPS in the treatment of esophageal variceal bleeding and refractory ascites, and to analyze and compare the clinical parameters (liver function, blood ammonia), and the occurrence of postoperative complications such as hepatic encephalopathy and shunt failure. Changes of portal blood flow index (ICGR15) after TIPS. Methods: from November 2015 to December 2016, 14 patients with hepatic cirrhosis and portal hypertension underwent TIPS from November 2015 to December 2016. Portal vein ECT,ICG test, portal vein pressure were measured during TIPS operation and stent implantation, blood routine examination, liver function, blood ammonia and hepatic portal ECT,ICG test were performed on the second day after operation, and the changes of clinical indexes were analyzed and compared. At the same time, follow up 2 weeks to 12 months, observe the occurrence of postoperative complications. Using SPSS18.0 statistical analysis, P0.05 as a significant difference. Results: all the 14 patients who underwent TIPS were successfully operated. 13 patients with esophageal variceal bleeding did not rebleed during hospitalization, and 1 patient with refractory ascites decreased ascites significantly after operation. 闂ㄨ剦鍘嬪姏鐢盩IPS鏈墠鐨，
本文编号：2276975
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